Bleeding from the nose; Epistaxis
Nosebleed can be caused by:
Repeated nosebleeds may be a symptom of another disease such as high blood pressure, a bleeding disorder, or a tumor of the nose or sinuses. Blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, may cause or worsen nosebleeds.
Nosebleeds are very common. Most nosebleeds occur because of minor irritations or colds.
The nose contains many small blood vessels that bleed easily. Air moving through the nose can dry and irritate the membranes lining the inside of the nose. Crusts can form that bleed when irritated. Nosebleeds occur more often in the winter, when cold viruses are common and indoor air tends to be drier.
Most nosebleeds occur on the front of the nasal septum. This is the piece of the tissue that separates the two sides of the nose. This type of nosebleed can be easy for a trained professional to stop. Less commonly, nosebleeds may occur higher on the septum or deeper in the nose such as in the sinuses or the base of the skull. Such nosebleeds may be harder to control. However, nosebleeds are rarely life threatening.
A nosebleed is loss of blood from the tissue lining the nose. Bleeding most often occurs in one nostril only.
To stop a nosebleed:
It may help to apply cold compresses or ice across the bridge of the nose. Do not pack the inside of the nose with gauze.
Lying down with a nosebleed is not recommended. You should avoid sniffing or blowing your nose for several hours after a nosebleed. If bleeding persists, a nasal spray decongestant (Afrin, Neo-Synephrine) can sometimes be used to close off small vessels and control bleeding.
Things you can do to prevent frequent nosebleeds include:
The provider will perform a physical exam. In some cases, you may be watched for signs and symptoms of low blood pressure from losing blood, also called hypovolemic shock.
You may have the following tests:
The type of treatment used will be based on the cause of the nosebleed. Treatment may include:
You may need to see an ear, nose, and throat (ENT) specialist for further tests and treatment.
Get emergency care if:
Call your health care provider if:
Pfaff JA, Moore GP. Otolaryngology. In: Marx JA, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 62.
Simmen D, Jones NS. Epistaxis. In: Flint PW, Haughey BH, Lund V, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 6th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 42.
Review Date: 8/25/2017
Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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